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Diminished DEFA6 Expression in Paneth Cells Is Associated with Necrotizing Enterocolitis

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Diminished DEFA6 Expression in Paneth Cells Is Associated with Necrotizing Enterocolitis Hindawi Gastroenterology Research and Practice Volume 2018, Article ID 7345426, 7 pages https://doi.org/10.1155/2018/7345426 Research Article Diminished DEFA6 Expression in Paneth Cells Is Associated with Necrotizing Enterocolitis 1 2 3 1 Laszlo Markasz , Alkwin Wanders, Laszlo Szekely, and Helene Engstrand Lilja 1Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden 2Department of Biomedical Sciences, Umeå University, Umeå, Sweden 3Department of Laboratory Medicine, Division of Pathology, Karolinska Institute, Stockholm, Sweden Correspondence should be addressed to Laszlo Markasz; [email protected] Received 5 July 2018; Accepted 28 August 2018; Published 21 October 2018 Academic Editor: Stephen Fink Copyright © 2018 Laszlo Markasz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Necrotizing enterocolitis (NEC) is the most common gastrointestinal disorder in premature infants with a high morbidity and mortality. Paneth cell dysfunction has been suggested to be involved in the pathogenesis of NEC. Defensin alpha- 6 (DEFA6) is a specific marker for Paneth cells acting as part of the innate immunity in the human intestines. The aim of this study was to investigate the expression of DEFA6 in infants with NEC. Materials and Methods. Infants who underwent bowel resection for NEC at level III NICU in Sweden between August 2004 and September 2013 were eligible for the study. Macroscopically vital tissues were selected for histopathological evaluation. All infants in the control group underwent laparotomy and had ileostomy due to dysmotility, and samples were taken from the site of the stoma. DEFA6 expression was studied by immunohistochemistry. Digital image analysis was used for an objective and precise description of the samples. Results. A total of 12 infants were included in the study, eight with NEC and four controls. The tissue samples were taken from the colon (n =1), jejunum (n =1), and ileum (n =10). Both the NEC and control groups consisted of extremely premature and term infants (control group: 25–40 gestational weeks, NEC group: 23–39 gestational weeks). The postnatal age at the time of surgery varied in both groups (control group: 4–47 days, NEC group: 4–50 days). DEFA6 expression in the NEC group was significantly lower than that in the control group and did not correlate with gestational age. Conclusion. The diminished DEFA6 expression in Paneth cells associated with NEC in this study supports the hypothesis that alpha-defensins are involved in the pathophysiology of NEC. Future studies are needed to elucidate the role of alpha-defensins in NEC aiming at finding preventive and therapeutic strategies against NEC. 1. Introduction intestinal ischemia, and colonization with pathogenic bacteria [1, 4]. The condition is an inflammation in the intestines Necrotizing enterocolitis (NEC) is a serious gastrointestinal related to a harmful overreaction of the immature immune disorder that affects 10–15 percent of premature infants with system to some insults [4]. The histological appearance a birth weight under 1500 g [1]. The mortality rates are up to shows bacterial invasion of the epithelia and early signs of 50% for infants requiring surgery [2]. Morbidity includes necrosis of the enterocytes at the top of some villi [5]. poor neurodevelopmental outcome and short bowel syn- Paneth cells are specialized epithelia that play a major drome [3]. role in the innate immune response [6]. They protect intes- Current evidence suggests a multifactorial cause of NEC tinal stem cells from pathogens, stimulate stem cell differen- [1]. Prematurity is the main risk factor, presumably due to tiation, and assist in repairing the intestine. The stem cell immaturity of gastrointestinal motility, intestinal barrier compartment is located at the base of the crypts, in the small function, and immune defence. Other contributing factors intestine interspersed by Paneth cells [7]. Paneth cells act are thought to be genetic predisposition, enteral feeding, through the production of antimicrobial proteins/peptides 2 Gastroenterology Research and Practice [8]. The principal antimicrobial peptides, the alpha- ganglion cells. The fourth control was later diagnosed with defensins DEFA5 and DEFA6, differ in function [9]. DEFA6 pseudoobstruction and has still an ileostomy. shows weak activity against bacteria [10], and its antimi- crobial function is activated by reducing milieu as a one- 2.2. Intestinal Tissue Samples and Immunohistochemistry. step mechanism by getting the more hydrophobic [11]. We performed both the immunohistochemistry and the DEFA6 may have a key role in protecting the small intes- image analysis blindly. All samples were sectioned and tine against invasion by diverse enteric pathogens through stained on the same occasion for comparable analysis. Intes- self-assembled peptide nanonets [12]. tinal tissues were fixed in 4% formaldehyde in PBS for 24 h at DEFA5 and DEFA6 mRNA levels are detectable at 13.5– 4°C. Embedded samples were sectioned (3 μm) and mounted 17 weeks of gestation in the small intestine but with markedly on SuperFrost slides. Samples were deparaffinized through a diminished expression until the middle of the third trimester graded series of xylol-ethanol. To determine the Paneth cell- [13]. Enteric DEFA5 and DEFA6 mRNA levels are signifi- specific expression of DEFA6, immunohistochemistry was cantly lower in fetus and term newborns than in adults, and performed by the Benchmark Ultra system (Ventana) and there are fewer numbers of Paneth cells in the crypts in the ultraView Universal DAB Detection Kit (Ventana) and extreme prematures than in term newborns and adults [13]. even counterstaining with hematoxylin-eosin was carried Recent studies suggest a key role for Paneth cells in the out. Tissue sections were incubated with a polyconal rabbit pathophysiology of NEC [5, 14–16]. The pathogenesis of anti-DEFA6 antibody (Prestige Antibodies® Powered by NEC and inflammatory bowel Crohn’s disease show many Atlas Antibodies, 1 : 800 dilution) after antigen retrieval in similarities [5, 17]. In Crohn’s, the production of both the CC2 buffer (Ventana) for 36 min. Negative control sec- DEFA5 and DEFA6 by Paneth cells is reduced [18]. Current tions were prepared by performing immunostaining proce- knowledge of alpha-defensins in NEC is scanty, and the dures without adding primary antibodies. Representative results seem to be controversial [19–21]. A better under- sections were digitally scanned with a 3DHISTECH scanner. standing of NEC is crucial to developing prevention and The images were exported in TIFF format (10x magnifica- treatment strategies. tion) with the virtual microscope software Panoramic Viewer The aim of the study was to investigate the expression of (3DHISTECH). DEFA6 in infants with NEC. 2.3. Image Analysis. ImageJ (freeware) was used for semiau- tomatic image analysis. The color detection of DAB staining 2. Materials and Methods was performed by the IHC Toolbox plugin in ImageJ, which can be effectively used to analyze samples stained by immu- 2.1. Study Population. Infants who underwent bowel resec- nohistochemistry [23]. The model for color detection of tion for NEC at level III NICU in Sweden between August brown pixels (which corresponded to the DAB staining and 2004 and September 2013 were eligible for the study the level of DEFA6 expression) was adjusted specifically for (Table 1). The study protocol was approved by the Regional the present project. The specificity of color detection was Ethical Review Board, and written informed consent was controlled visually. Working with image stacks during the obtained from the parents. evaluation process allowed the analysis to be made compara- Oral feeding with breast milk was started within two ble between images. After color detection of DAB staining, hours after birth in premature infants both in the control the RGB color images were converted to 8-bit files. Inversion and the NEC groups. NEC was diagnosed by radiological of the pixel intensity values resulted in higher pixel intensity and clinical features and staged according to the criteria of corresponding to higher DEFA6 expression. The workflow is Bell et al. [22]. NEC diagnosis was confirmed during surgery presented in Figures 1(a)–1(e). Before analysis, the same and by histopathological evaluation. Infants with NEC were threshold window was set on each image in order to filter treated with broad-spectrum antibiotics, and enteral feeding unspecific too high and/or too low pixel values. Besides the was ceased prior to surgery. Infants with NEC underwent advantages of the method, even some limitations could be bowel resection, and an enterostomy was created. Those considered: the antigen retrieval process and the staining samples that represented macroscopically vital tissue, from process are not easy to standardize and both can influence ends of the resected intestine, were selected for further histo- DAB intensity. Thus, the measured intensity levels in differ- pathological evaluation, and samples with complete mucosal ent studies are not directly comparable if they are performed erosion were excluded. at different time points. The controls all presented with delay to pass meconium, abdominal distention, and bilious vomiting, and they under- 2.4. DEFA6 Expression. Comparison of the general expres- went laparotomy
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